The Four Core Principles of Bioethics: Definitions and Application

Foundational Concepts in Ethical Reasoning

Principle: An essential norm in a system of moral thought, forming the basis of moral reasoning. Principles help us formulate rules and practical guidance.

Respect for Autonomy

Definition: A principle requiring respect for the decision-making capacities of autonomous persons.

Understanding Autonomy

• Autonomy: Freedom from external constraint and the presence of critical mental capacities such as understanding, intending, and voluntary decision-making capacity.
• Personal Autonomy: Personal self-governance—the personal rule of the self by adequate understanding while remaining free from controlling interferences by others and from personal limitations that prevent choice.

Diminished Autonomy

To have diminished autonomy is to be in some respect controlled by others or incapable of deliberating or acting on the basis of one's own desires and plans.

Respecting Autonomous Agents

To respect an autonomous agent is to recognize with due appreciation that person's capacities and perspectives, including their right to hold certain views, to make certain choices, and to take certain actions based on personal values and beliefs.

Obligations Related to Autonomy

Negative Obligation

Autonomous actions should not be subjected to controlling constraints by others.

Positive Obligation

This principle requires both respectful treatment in disclosing information and actions that foster autonomous decision-making.

Related Concepts

• Respect: Involves acknowledging the value and decision-making rights of persons and enabling them to act autonomously.
• Disrespect: Involves attitudes and actions that ignore, insult, demean, or are inattentive to others' rights of autonomy.

Non-maleficence

The core maxim is primum non nocere (above all, do no harm).

Intentionally or negligently caused harm is a fundamental moral wrong. Providers should strive to create a positive balance of goods over inflicted harms.

Beneficence

Beneficence is a moral obligation to act for the benefit of others. No demand is more important when taking care of patients: the welfare of patients is medicine's context and justification.

Applying Beneficence

This principle requires us to help others further their important and legitimate interests, often by preventing or removing possible harms.

Providers should come to the assistance of those in need of treatment or in danger of injury by:

• Providing treatment and care.
• Helping someone access care (e.g., financial assistance, transport).

Balancing Harms and Benefits

Beneficence often requires a balance between harms and benefits. Providers should aim to maximize benefits or minimize harms, or balance benefits against risks.

Justice

Justice is about treating others fairly; giving others their due, or what they are owed.

Distributive Justice

Distributive justice refers to the fair, equitable, and appropriate distribution of goods in society. This includes healthcare resources (such as medical treatments, appointments, organs) and healthcare costs.

Formal Principle of Justice

The minimal formal principle states that like cases should be treated alike: equals ought to be treated equally, and unequals unequally.